Skip to main content
SSO 2024 Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Recorded for On-Demand Viewing
Recorded for On-Demand Viewing
Back

Disparities in Surgical Oncologic Care

E117: Food Environment Impact on Gastrointestinal Cancer Disparities in the US

Introduction: Social conditions and dietary behaviors have been implicated in the rising burden of gastrointestinal cancers (GIC). The “food environment” reflects these influences through food availability, nutritional assistance, and social determinants of health. Using the US Department of Agriculture-Food Environment Atlas (FEA), we sought to quantify the impact of food environment on GIC patient prognosis.


Methods: Patients diagnosed with GIC between 2013-2017 were identified using the SEER database. FEA scores were based on 282 county-level variables of food security, store-restaurant availability, SNAP/WIC enrollment, pricing & taxes, and producer vicinity adjusted for factors of socioeconomic status, race-ethnicity, transportation access, and comorbidities. Relative FEA rankings across US counties were averaged into a composite score and assigned to patients by county-of-residence. Associations of FEA, cancer stage, and survival were analyzed by multiple logistic regression and cox-proportional hazard models relative to White/non-White race/ethnicity.


Results: Among 287,148 patients, the most common GIC sites were colon (n=97,942, 34%), pancreas (n=49,785, 17.3%), liver (n=31,098, 11.0%), and esophagus (n=16,271, 5.7%). Worse food environment was independently associated with increased odds of late-stage diagnosis (esophageal OR 1.03, 95%CI 1.01–1.05; hepatic OR 1.06, 95%CI 1.03–1.08; pancreatic OR 1.04, 95%CI 1.01–1.06), as well as colorectal cancer among non-White patients only (OR 1.04, 95%CI 1.03-1.06). Worse food environment was also associated with worse 3-year survival (colon OR 1.03, 95%CI 1.01–1.04; hepatic OR 1.12, 95%CI 1.08–1.17; gastric OR 1.07, 95%CI 1.01–1.13) among the entire cohort and non-White patients (colon OR 1.03, 95%CI 1.01–1.06; hepatic OR 1.13, 95%CI 1.07–1.19; gastric OR 1.07, 95%CI 1.01–1.13). Similar associations were noted relative to overall survival among the entire cohort (biliary tract HR 1.03, 95%CI 1.01-1.05; esophageal HR 1.02, 95%CI 1.01–1.04; hepatic HR 1.07, 95%CI 1.06–1.09; pancreatic HR 1.04, 95%CI 1.02–1.05; rectum HR 1.03, 95%CI 1.01-1.04; gastric HR 1.05, 95%CI 1.03-1.07) and among non-White patients (biliary HR 1.04, 95%CI 1.01-1.07; colon HR 1.03, 95%CI 1.01-1.05; esophageal HR 1.05, 95%CI 1.02-1.08; hepatic HR 1.08, 95%CI 1.06-1.10) (all p< 0.003).

Conclusions: Food environment was independently associated with late-stage tumor presentation and worse 3-year and overall mortality among GIC patients. Interventions to address inequities across communities relative to food environments are needed to alleviate disparities in cancer care.

Learning Objectives:

  • Showcase the impact of food environment on national prognostic disparities in gastrointestinal cancer
  • Highlight the utility of the US Department of Agriculture-Food Environment Atlas for conducting geospatial analyses of community-level social factors of food access
  • Demonstrate statistical methodologies of high-dimensional characterizations of widely varying clinicodemographic factors in understanding surgical-oncologic disparities